| NPI | 1689808651 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 56208) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 27021) |
| Enumeration Date | 2009-05-06 |
| Last Update Date | 2017-03-01 |